Characterising risk of non-steroidal anti-inflammatory drug-related acute kidney injury: a retrospective cohort study

Sharon X Lin; Thomas Phillips; David Culliford; Christopher Edwards; Christopher Holroyd; Kinda Ibrahim; Ravina Barrett; Clare Howard; Ruth Johnson; Jo Adams; Mathew Stammers; Adam Rischin; Paul Rutter; Nicola Barnes; Paul J Roderick; Simon Ds Fraser

doi:10.3399/BJGPO.2021.0208

Characterising risk of non-steroidal anti-inflammatory drug-related acute kidney injury: a retrospective cohort study

BJGP Open. 2022 Mar 22;6(1):BJGPO.2021.0208. doi: 10.3399/BJGPO.2021.0208. Print 2022 Mar.

Authors

Sharon X Lin¹, Thomas Phillips^{2

3}, David Culliford¹, Christopher Edwards², Christopher Holroyd², Kinda Ibrahim¹, Ravina Barrett⁴, Clare Howard⁵, Ruth Johnson⁶, Jo Adams⁷, Mathew Stammers², Adam Rischin⁸, Paul Rutter⁹, Nicola Barnes⁹, Paul J Roderick¹⁰, Simon Ds Fraser¹¹

Affiliations

¹ National Institute for Health Research Wessex Applied Research Collaboration, University of Southampton, Southampton General Hospital, Southampton, UK.
² University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK.
³ Clinical Research Network Wessex, Southampton, UK.
⁴ School of Pharmacy and Biomolecular Sciences, Cockcroft Building, University of Brighton, Brighton, UK.
⁵ Wessex Academic Health Science Network, Southampton Science Park, Southampton, UK.
⁶ Commissioning Support Unit, NHS South, Central and West, Hampshire, UK.
⁷ Health Sciences, University of Southampton, Southampton, UK.
⁸ Alfred Health, Melbourne, Australia.
⁹ School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
¹⁰ School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.
¹¹ School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK s.fraser@soton.ac.uk.

Abstract

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain and inflammation. NSAID complications include acute kidney injury (AKI), causing burden to patients and health services through increased morbidity, mortality, and hospital admissions.

Aim: To measure the extent of NSAID prescribing in an adult population, the degree to which patients with potential higher risk of AKI were exposed to NSAIDs, and to quantify their risk of AKI.

Design & setting: Retrospective 2-year closed-cohort study.

Method: A retrospective cohort of adults was identified from a pseudonymised electronic primary care database in Hampshire, UK. The cohort had clinical information, prescribing data, and complete GP- and hospital-ordered biochemistry data. NSAID exposure (minimum one prescription in a 2-month period) was categorised as never, intermittent, and continuous, and first AKI using the national AKI e-alert algorithm. Descriptive statistics and logistic regression were used to explore NSAID prescribing patterns and AKI risk.

Results: The baseline population was 702 265. NSAID prescription fell from 19 364 (2.8%) to 16 251 (2.4%) over 2 years. NSAID prescribing was positively associated with older age, female sex, greater socioeconomic deprivation, and certain comorbidities (diabetes, hypertension, osteoarthritis, and rheumatoid arthritis) and negatively with cardiovascular disease (CVD) and heart failure. Among those prescribed NSAIDs, AKI was associated with older age, greater deprivation, chronic kidney disease (CKD), CVD, heart failure, diabetes, and hypertension.

Conclusion: Despite generally good prescribing practice, NSAID prescribing was identified in some people at higher risk of AKI (for example, patients with CKD and older) for whom medication review and NSAID deprescribing should be considered.

Keywords: acute kidney injury; anti-inflammatory agents, non-steroidal; large database research; primary health care.